ED drugs<\/a> like sildenafil, but only the generic version, and sometimes with limitations.<\/p>\nYour plan may not cover sexual dysfunction medications at all or only allow a certain number of pills each month. So if your doctor writes a prescription for 30 pills, it may get declined \u2014 even if your plan covers four or six.<\/p>\n
A denied claim doesn\u2019t necessarily mean sildenafil isn\u2019t covered. It could be that the pharmacy benefit manager wants you to use a different dosage or number of pills, or it may require prior authorization for the prescription to be approved.<\/p>\n
Does private insurance cover sildenafil?<\/h2>\n
It can be, but commercial insurance plans are much more likely to cover the generic version of the medication rather than the brand-name. Even then, there may be various restrictions and requirements, including:<\/p>\n
The number of pills covered per month being less than what your doctor prescribed<\/p>\n
Prior authorization being needed from your doctor<\/p>\n
Higher copays for nonpreferred pharmacies<\/p>\n
Use of a preferred generic ED drug before another one via step therapy<\/p>\n
No coverage for drugs specifically prescribed for erectile dysfunction<\/p>\n
The fastest way to find out if your insurance covers sildenafil is to look up your plan\u2019s formulary online and search for \u201cViagra\u201d and \u201csildenafil.\u201d You\u2019ll want to look for any notes that specify QL (quantity limit), PA (prior authorization), or ST (step therapy). You can also give the number on the back of your insurance card a call and ask them about the quantity coverage, copay requirements, and whether or not tadalafil (another ED drug) is preferred. If you\u2019re trying to decide between the two medications, be sure to review our guide on Cialis versus Viagra.<\/p>\n
Does Medicare cover Viagra?<\/h2>\n
Original Medicare (Parts A and B) typically doesn\u2019t cover outpatient medications like Viagra. Part D plans normally don\u2019t cover drugs when they\u2019re prescribed for erectile dysfunction. There may be some coverage under Medicare Advantage or Part D plans, but brand-name Viagra is generally not covered.<\/p>\n
It can depend on the diagnosis, too, because sildenafil is also used to treat pulmonary arterial hypertension, which is a serious condition that affects the lungs and the heart. Medicare may cover the drug if it\u2019s prescribed for that specific ailment, even if it\u2019s not covered when it\u2019s prescribed for ED.<\/p>\n
Doctors shouldn\u2019t alter a diagnosis to get a medication covered. If an insurance company suspects \u201cupcoding\u201d or \u201cstaging,\u201d they may ask for proof that the medication was actually prescribed for the noted reason.<\/p>\n
Does Medicaid cover sildenafil?<\/h2>\n
Medicaid coverage for ED drugs tends to be sparse. Some state programs may cover the generic version of sildenafil, but it\u2019s typically only when it\u2019s prescribed for pulmonary arterial hypertension, rather than erectile dysfunction.<\/p>\n
Each state\u2019s Medicaid program is run independently, so it can be hard to sort through the various rules and restrictions. It\u2019s best to contact the specific Medicaid office of your state to ask about coverage rather than searching online.<\/p>\n
What can you do if your claim was denied?<\/h2>\n
Ask the pharmacist for the cash price for the generic sildenafil. It can be much cheaper than using insurance, particularly if you have a discount card you can use at the register. A coupon can\u2019t be used in combination with insurance, so ask the pharmacist to compare the two prices.<\/p>\n
Another thing your doctor could do is:<\/p>\n
\n- Write the prescription for the number of pills that your insurance plan covers<\/li>\n
- Get prior authorization from your plan<\/li>\n
- Write the prescription for the generic version of sildenafil<\/li>\n
- Write the prescription for the generic version of tadalafil if it\u2019s a preferred medication<\/li>\n
- Appeal the decision if there\u2019s a documented medical reason<\/li>\n<\/ul>\n
Buying \u201cherbal Viagra\u201d or other unregulated sexual enhancement drugs isn\u2019t a good idea, either. The FDA has found numerous counterfeit pills that contain either sildenafil or tadalafil, but with unknown dosages, so you could be putting your health at risk.<\/p>\n
Insurance coverage for sildenafil can be inconsistent, but the medication itself shouldn\u2019t be inaccessible or unaffordable. For most men, asking around about the generic version of sildenafil (and asking about the cash price when picking up the prescription) is the best place to start.<\/p>\n","protected":false},"excerpt":{"rendered":"
If your goal is affordable, effective, reliable ED treatment without bureaucracy, you’re in the right place. Browse our full ED treatment section and take control of your health\u2014on your terms.<\/p>\n","protected":false},"author":6,"featured_media":1260,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-1255","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sexual-health"],"_links":{"self":[{"href":"https:\/\/www.faastpharmacy.com\/blog\/wp-json\/wp\/v2\/posts\/1255","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.faastpharmacy.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.faastpharmacy.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.faastpharmacy.com\/blog\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/www.faastpharmacy.com\/blog\/wp-json\/wp\/v2\/comments?post=1255"}],"version-history":[{"count":3,"href":"https:\/\/www.faastpharmacy.com\/blog\/wp-json\/wp\/v2\/posts\/1255\/revisions"}],"predecessor-version":[{"id":1413,"href":"https:\/\/www.faastpharmacy.com\/blog\/wp-json\/wp\/v2\/posts\/1255\/revisions\/1413"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.faastpharmacy.com\/blog\/wp-json\/wp\/v2\/media\/1260"}],"wp:attachment":[{"href":"https:\/\/www.faastpharmacy.com\/blog\/wp-json\/wp\/v2\/media?parent=1255"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.faastpharmacy.com\/blog\/wp-json\/wp\/v2\/categories?post=1255"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.faastpharmacy.com\/blog\/wp-json\/wp\/v2\/tags?post=1255"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}